42 U.S.C. § 1320c
Purpose
The purpose of this part is to establish the contracting process which the Secretary must follow pursuant to the requirements of section 1395y(g) of this title, including the definition of the quality improvement organizations with which the Secretary shall contract, the functions such quality improvement organizations are to perform, the confidentiality of medical records, and related administrative matters to facilitate the carrying out of the purposes of this part.
Notes of Decisions
Cited in 54
cases (1 in the last 5 years), 1974–2025 · leading case: Consumers' Checkbook, Ctr. for the Study of Servs. v. United States Dep't of Health & Human Servs., 554 F.3d 1046 (D.C. Cir. 2009).
Consumers' Checkbook, Ctr. for the Study of Servs. v. United States Dep't of Health & Human Servs., 554 F.3d 1046 (D.C. Cir. 2009). “See 42 U.S.C. § 1320c et seq. (elaborating upon section 1395y(g)).”
Robinson v. Magovern, 83 F.R.D. 79 (W.D. Pa. 1979). “Under this program which is intended “to promote the effective, efficient, and economical delivery of health care services of proper quality,” practitioners who provide health care to patients under federally-funded medical programs can be reimbursed only when the local PSRO…”
Pub. Citizen Health Rsch. Grp. v. Dep't of Health, Educ. & Welfare, 477 F. Supp. 595 (D.D.C. 1979). “42 U.S.C. § 1320c — 7(c) (1976). 1 Specifically, NCMF must determine: (a) whether the inpatient services rendered are medically necessary; (b) whether such services meet professional standards of quality; and (c) whether appropriate care could be provided as effectively on an…”
Am. Hosp. Ass'n v. Otis R. Bowen, Sec'y, H.H.S., 834 F.2d 1037 (D.C. Cir. 1987). “382 (1982), 42 U.S.C. §§ 1320c et seq., which called for HHS to contract with “peer review organizations,” or PROs, private organizations of doctors that would monitor “some or all of the professional activities” of the provider of Medicare services in their areas.”
Beverly Health & Rehab. Servs., Inc. v. Thompson, 223 F. Supp. 2d 73 (D.D.C. 2002). “See 42 U.S.C. § 1320c. The new process required HHS to contract with "peer review organizations" ("PROs”), composed of doctors who would monitor "some or all of the professional activities of the provider of Medicare services in their areas.”
Mikes v. Straus, 274 F.3d 687 (2d Cir. 2001). “Compare 42 U.S.C. § 1320c—5(a)(1) (1994) (practitioner shall assure that the service “will be provided economically and only when, and to the extent, medically necessary”), with id.”
N.G. v. Downey Reg'l Med. Ctr., 140 F. Supp. 3d 1036 (C.D. Cal. 2015). “” See 42 U.S.C. § 1320c. As discussed above, the subchapter pertains to the functions of peer review organizations.”
Am. Med. Ass'n v. Mathews, 429 F. Supp. 1179 (N.D. Ill. 1977). “But both hospitals and pharmacies will probably still carry inventories of non-MAC drugs to serve patients not covered by Medicare or Medicaid and to fill prescriptions for Medicaid and Medicare patients for whom the physician has certified the medical necessity of the non-MAC…”
B. G. M. Enter. v. Harris, 482 F. Supp. 1073 (D. Mont. 1980). “42 U.S.C. § 1320c — 4(a)(l). A physician who is a member of the PSRO may not review a patient’s health care services for which he was directly responsible, nor may he review services provided in or by an institution in which he or his family has a significant financial interest.”
United States v. Jeffrey Jay Rutgard, 116 F.3d 1270 (9th Cir. 1997). “42 U.S.C. § 1320c- *1276 5(a)(1). Under the statute, the Secretary of Health and Human Services regulates the administration of the program with regulations now totalling over 1,600 pages.”
Fischer v. United States, 529 U.S. 667 (2000). “" 42 U. S. C. § 1320c5(a). Peer review organizations monitor providers' compliance with these and other obligations.”
Todd v. South Jersey Hosp. Sys., 152 F.R.D. 676 (D.N.J. 1993). “To avoid further confusion, the following definitions shall govern in this opinion and order, and its enforcement: Peer Review Organization (PRO): A specific statutorily-mandated organization, created and operated pursuant to 42 U.S.C. § 1320c, et seq. Utilization Review…”
— 42 U.S.C. § 1320c(1) — 1 case
Am. Med. Ass'n v. Mathews, 429 F. Supp. 1179 (N.D. Ill. 1977). “But both hospitals and pharmacies will probably still carry inventories of non-MAC drugs to serve patients not covered by Medicare or Medicaid and to fill prescriptions for Medicaid and Medicare patients for whom the physician has certified the medical necessity of the non-MAC…”
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